Field evaluation of a rapid point-of-care assay for targeting antibiotic treatment for trachoma control: a comparative study

被引:55
作者
Michel, CEC
Solomon, AW
Magbanua, JPV
Massae, PA
Huang, L
Mosha, J
West, SK
Nadala, ECB
Bailey, R
Wisniewski, C
Mabey, DCW
Lee, HH [1 ]
机构
[1] Univ Cambridge, Dept Haematol, Diagnost Dev Unit, Cambridge, England
[2] London Sch Hyg & Trop Med, Clin Res Unit, London WC1, England
[3] Tumaini Univ, Kilimanjaro Ctr Community Ophthalmol, Moshi, Tanzania
[4] Johns Hopkins Univ, Dana Ctr Prevent Ophthalmol, Baltimore, MD USA
基金
英国惠康基金;
关键词
D O I
10.1016/S0140-6736(06)68695-9
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Trachoma results from repeated episodes of conjunctival infection with Chlamydia trachomatis and is the leading infectious cause of blindness. To eliminate trachoma, control programmes use the SAFE strategy (Surgery, Antibiotics, Face cleanliness, and Environmental improvement). The A component is designed to treat C trachomatis infection, and is initiated on the basis of the prevalence of the clinical sign trachomatous inflammation-follicular (TF). Unfortunately, TF correlates poorly with C trachomatis infection. We sought to assess a newly developed point-of-care (POC) assay compared with presence of TF for guiding the use of antibiotics for trachoma control. Methods We compared performance outcomes of the POC assay and presence of TF using commercial PCR as a comparator in 664 children aged 1-9 years in remote, trachoma-endemic villages in Tanzania. Signs of trachoma were graded according to the WHO simplified trachoma grading system. Findings Of 664 participants, 128 (19%) were positive for ocular C trachomatis infection by PCR. Presence of TF had a sensitivity of 64.1% (95% CI 55.8-72.4), specificity of 80.2% (76.8-83.6), and positive predictive value of 43.6% (36.5-50.7). By contrast, the POC assay had a sensitivity of 83.6% (77.2-90.0), specificity of 99.4% (98.8-100.0), and positive predictive value of 97.3% (94.2-100.3). Interagreements and intra-agreements between four novice operators were 0.988 (0.973-1.000) and 0.950 (0.894-1.000), respectively. Interpretation The POC assay is substantially more accurate than TF prevalence in identifying the presence or absence of infection. Additional studies should assess the use of the assay in the planning and monitoring of trachoma control activities.
引用
收藏
页码:1585 / 1590
页数:6
相关论文
共 29 条
[1]  
Bailey R, 2001, B WORLD HEALTH ORGAN, V79, P233
[2]  
Baral K, 1999, B WORLD HEALTH ORGAN, V77, P461
[3]   Impact of azithromycin administration for trachoma control on the carriage of antibiotic-resistant Streptococcus pneumoniae [J].
Batt, SL ;
Charalambous, BM ;
Solomon, AW ;
Knirsch, C ;
Massae, PA ;
Safari, S ;
Sam, NE ;
Everett, D ;
Mabey, DCW ;
Gillespie, SH .
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, 2003, 47 (09) :2765-2769
[4]  
Brade H, 1997, J ENDOTOXIN RES, V4, P67, DOI 10.1177/096805199700400108
[5]   Which members of a community need antibiotics to control trachoma?: Conjunctival Chlamydia trachomatis infection load in Gambian villages [J].
Burton, MJ ;
Holland, MJ ;
Faal, N ;
Aryee, EAN ;
Alexander, NDE ;
Bah, M ;
Faal, H ;
West, SK ;
Foster, A ;
Johnson, GJ ;
Mabey, DCW ;
Bailey, RL .
INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE, 2003, 44 (10) :4215-4222
[6]   Role of flies and provision of latrines in trachoma control: cluster-randomised controlled trial [J].
Emerson, PM ;
Lindsay, SW ;
Alexander, N ;
Bah, M ;
Dibba, SM ;
Faal, HB ;
Lowe, K ;
McAdam, KPWJ ;
Ratcliffe, AA ;
Walraven, GEL ;
Bailey, RL .
LANCET, 2004, 363 (9415) :1093-1098
[7]  
Frick KD, 2001, B WORLD HEALTH ORGAN, V79, P201
[8]   Adverse and beneficial secondary effects of mass treatment with azithromycin to eliminate blindness due to trachoma in Nepal [J].
Fry, AM ;
Jha, HC ;
Lietman, TM ;
Chaudhary, JSP ;
Bhatta, RC ;
Elliott, J ;
Hyde, T ;
Schuchat, A ;
Gaynor, B ;
Dowell, SF .
CLINICAL INFECTIOUS DISEASES, 2002, 35 (04) :395-402
[9]  
GRAYSTON JT, 1985, REV INFECT DIS, V7, P717
[10]   Comparison of methods for detection of Chlamydia trachomatis and Neisserza gonorrhoeae using commercially available nucleic acid amplification tests and a liquid pap smear medium [J].
Koumans, EH ;
Black, CM ;
Markowitz, LE ;
Unger, ER ;
Pierce, A ;
Sawyer, MK ;
Papp, JR .
JOURNAL OF CLINICAL MICROBIOLOGY, 2003, 41 (04) :1507-1511